POS0161 WORK STATUS IN PATIENTS WITH INFLAMMATORY RHEUMATIC MUSCULOSKELETAL DISEASES: RESULTS OF A BELGIAN COMPARATIVE STUDY
Authors: A. S. De Craemer, I. Desimpele, L. Delmez, L. Deroo, T. Renson, S. De Mits, V. Smith, P. Jacques, D. Elewaut, P. Carron, F. Van den Bosch
Journal: Annals of the Rheumatic Diseases (2022)

Background Inflammatory Rheumatic Musculoskeletal Diseases (RMD) constitute a heterogeneous group of chronic disorders with a potential major individual and socio-economic burden. RMD patients often report work-related difficulties (e.g. productivity loss, sick leave, work disability) which contribute significantly to indirect costs and may lead to additional premiums or exclusion when contracting private insurances. However, work-related epidemiological data in Belgium date back to a pre-biologics era, albeit that diagnosis, management and treatment strategies have drastically improved in the last decade. Objectives To investigate actual work participation status of inflammatory RMD patients in Belgium, and to benchmark these data to the general Flemish population. Methods During an outpatient visit at the rheumatology clinic of Ghent University Hospital, a tertiary hospital in the Flemish region, adult patients with spondyloarthritis (SpA), rheumatoid arthritis (RA), and systemic sclerosis (SSc) were questioned on their socio-economic status (May 2018 to June 2021). SpA patients fulfilled the ASAS classification criteria for axial or peripheral SpA. RA patients fulfilled the 2010 ACR/EULAR classification criteria or had undifferentiated arthritis most suggestive for RA. SSc patients fulfilled the LeRoy and Medsger’s criteria. Employment rate, weekly working hours and work disability were compared to the general Flemish population (Dutch-speaking part of the country) in 2019 ( https://statbel.fgov.be/en ); data on sick leave were deduced from the 2018 national Health Interview Survey. Results Among the 483 participants, 262/275 (95%) SpA, 63/102 (62%) RA, and 83/106 (78%) SSc were at a work-productive age (&lt;65 y/o). Table 1 summarizes socio-demographic and clinical characteristics. Table 1. SpA (n=262) RA (n=63) SSc (n=83) Male 148 (56%) 15 (24%) 18 (22%) Age (y) 40.7±11.0 53.5±10.8 49.9±10.6 Symptom duration (y)* 7.8 (4.7-15.7) 3.9 (1.4-5.8) 5.8 (2.8-11.5) Age at diagnosis (y) 32.6±11.1 48.3±12.0 43.9±10.7 Biomarker† 170 (70%) 52 (82%) 46 (55%) Disease activity†† 1.9±1.0 2.1±1.0 4 (1-8) Functional index** 2.3±2.2 67±14 - EQ-5D scale 0.79±0.22 0.80±0.18 0.74±0.24 Biologics treatment 123 (58%) 15 (24%) 7 (8%) Educational level Low 100 (38%) 36 (57%) 53 (64%) High 162 (62%) 27 (43%) 30 (36%) Classification criteria ASAS: ACR/EULAR 2010: Leroy &amp; Medsger: axSpA: 192 (73%) 46 (73%) LSSC: 21 (25%) perSpA: 70 (27%) LcSSc: 47 (57%) DcSSc: 15 (18%) † HLA B27 (SpA), RF/ACPA (RA), SSc-related auto-antibodies (SSc). †† ASDAS-CRP (SpA), DAS28 (RA), mRSS (SSc). *Disease duration from first non-Rayneud phenomenon in SSc. **BASFI (SpA), Michigan Hand Outcomes Questionnaire (RA). Crude employment rates were 82% in SpA, 56% in RA and 63% in SSc. Age- and sex-adjusted employment rates (indirect standardization) were respectively 75%, 68%, and 66%, corresponding to a standardized employment ratio of 1.00 (95% CI 0.87 – 1.14) for SpA, 0.89 (0.64 – 1.24) for RA, and 0.88 (CI 0.67 – 1.15) for SSc. SpA patients worked 39.5±10.9h/week, compared to 40.9±16.9h in RA and 33.0±12.4h in SSc (p=0.003). Flemish employees worked on average 39.7h (full-time) and 25.7h (part-time) per week. In the working population, 48% of SpA patients, 53% RA and 78% SSc reported sick leave in the previous year, compared to 42% in Flanders. Long-term work disability was reported by respectively 10%, 17% and 20% of patients (p=0.03) compared to 9% in the reference population. The median retention time on the labour market was not significantly different between SpA (42.1 years), RA (42.1 years) and SSc (41.2 years) (p=0.94, Figure 1). Figure 1. retention time on the labour market since start of patient’s professional career. Conclusion Our data refute the common perception that patients with RMDs, especially inflammatory joint diseases, have significantly worse work outcomes compared to the general population. In an era of early diagnosis and treatment, more recent datasets could be used to realistically estimate the odds of these important health economic outcomes. Acknowledgements The Ghent University Hospital is member of the Flemish Network on rare connective tissue diseases and of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases (ERN ReCONNET). Disclosure of Interests None declared